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Chest Pain in the Setting of Altered Mental Status

Tjoeng, Yuen Lie MD; Mickley, Megan MD; Prentiss, Kimball MD

doi: 10.1097/PEC.0000000000000589
Illustrative Cases

We report on a young adult female presenting with altered mental status and chest pain. Timely review of her electronic medical record revealed a history of panhypopituitarism with poor medication adherence, although this was unknown at the time of her initial evaluation.

The patient required hormone replacement and significant fluid resuscitation, followed by definitive treatment with a pericardiocentesis. She was discharged home on hospital day 4, with normalization of her diminished left ventricular ejection fraction at her 1-month follow-up.

Although panhypopituitarism and cardiac tamponade are rare diagnoses, we highlight the management of severe hypothyroidism, the importance of early administration of hydrocortisone for panhypopituitarism, and the need for aggressive volume expansion to maintain preload in cardiac tamponade.

From Boston Medical Center.

Disclosure: The authors declare no conflict of interest.

Reprints: Megan Mickley, MD, Boston Medical Center, 88 E Newton St, Vose Hall 529, Boston, MA 02118 (e-mail:

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